Background Fatigue is a common symptom in patients with Lyme disease. Objective The purpose of this study was to characterize fatigue in untreated adult patients presenting with erythema migrans. Selected variables were assessed to determine if any correlated with the presence or severity of fatigue. Methods Fatigue was assessed on the day of the evaluation by a visual analogue scale (VAS), over the past 14 days by the 11-item fatigue severity scale (FSS-11) and over the past 28 days based on a question from the 36-item Short Form General Health Survey version 2. Results 51 patients with erythema migrans whose mean age was 49.8 years, and 33 (64.7%) of whom were male, were evaluated in this study. The three measures of fatigue were positively correlated with one another (p ≤ 0.01). 26 (51%) had fatigue based on a VAS score above 0. 10 (19.6%) had severe fatigue based on an FSS-11 score of ≥ 4. The strongest correlate for higher fatigue scores was having a greater number of symptoms in addition to fatigue. Conclusion Based on the FSS-11 assessment tool, approximately 20% of early Lyme patients have severe fatigue. Having a high total number of symptoms was associated with both the presence and severity of fatigue. Since prior studies have demonstrated the presence of elevated levels of pro-inflammatory cytokines and other molecules in the serum of highly symptomatic patients with erythema migrans, the symptom of fatigue in early Lyme disease may be a component of what has been referred to as the acute sickness response.

Continuous renal replacement therapy (CRRT) is a well-established supportive treatment for acute kidney injury in pediatric intensive care units. Knowing its basic aspects allows a rational approach to therapy, making this therapeutic option a more adaptable treatment for individual patient. Different strategies may be used in the same child, depending on the clinical situation and the changes that may present throughout the clinical course. This article explains the physical principles, modalities of continuous renal replacement therapies, and membrane and filter characteristics in order to better understand the transmembrane transport of fluids and solutes in continuous renal replacement therapy.Abbreviations: CRRT= Continuous renal replacement therapy; SCUF = Slow continuous ultrafiltration therapies; FF = Filtration fraction; CVVH = Continuous venovenous hemofiltration; AKI = Acute kidney injury; CVVHD = Continuous venovenous hemodialysis; CVVHDF = Continuous venovenous hemodiafiltration; SLEDD = Sustained low-efficiency daily dialysis, EDDf = Extended daily dialysis with filtration, PDIRRT = Prolonged daily intermittent renal replacement therapyCitation: Obando E, López E, Montoya D, Fernández-Sarmiento J. Continuous renal replacement therapy: understanding the foundations applied to pediatric patients. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S39-S45

Black Girlhood Studies provide an authentic vantage point for the narratives and experiences of young Black girls today. Black women working alongside Black girls play a central role in the development of the field, yet their narratives and experiences as former Black girls remain decentered. Using autoethnography, we describe the experiences of seven community-engaged Black women scholars, including one professor who teaches Black Girlhood Studies courses and is the co-creator of a virtual space for middle school Black girls called Black Girl Magic (BGM), and six undergraduate students who are enrolled in the course and/or serve as BGM co-facilitators. We discuss how teaching, learning, and practicing Black Girlhood Studies shapes a collective rememorying process for Black women seeking to make their girlhood experiences legible.

The management of infections caused by carbapenem-resistant organisms has been a challenge. We report a rare emergence of resistance to the novel beta-lactam/ beta-lactamase combination ceftolozane/tazobactam by Klebsiella pneumoniae, causing urinary tract infection. The K. pneumoniae, in this case, was reported to be sensitive to the other novel beta-lactam/ beta-lactamase combination of ceftazidime/avibactam. The timely administration of ceftazidime/avibactam resulted in prompt clinical resolution of the urinary tract infection caused by an extensively drug-resistant K. pneumoniae.

Background Infectious endocarditis (IE) remains a disease of high mortality, complications and a severe burden to the healthcare system despite advances in diagnostic techniques and treatments. There are several investigations of IE using a nation-based population cohort, however, with limited focus on septic emboli-related complications. Figure 1. Flowchart of the study cohort. IE=Infective Endocarditis Methods We used the 2016 to 2018 National Readmission Database (NRD) to identify a primary diagnosis of admissions among adults (Age≥18) with IE. International Statistical Classification (ICD-10) codes were used to identify patients with a primary diagnosis of IE who experienced in-hospital septic emboli-related complications. Primary outcomes were mortality, length of stay, total cost and 30-day all-cause readmission. Uni- and Multivariate Linear, Logistic and Cox regression were used to assess statistical significance and a two-sided p-value less than 0.05 was considered significant. Results A total of 30,870 patients were admitted with a primary diagnosis of IE from 2016 to 2018 (December admissions were omitted). After excluding the patients with omitted information, 30,289 patients went into analysis. Baseline characteristics are shown in Table 1. Septic emboli-related complications were seen in 42.6% of the patients; about 10% had central nervous system (CNS) complications, 7% had cardiac complications and 20.2% had respiratory complications. Embolic complications of any kind were associated with higher mortality (Odds Ratio = 2.11 [1.74 – 2.54]), a longer length of stay (5.72 days [5.17 – 6.27]) and higher total costs (21,812 dollars [19,856 – 23,769]) while adjusted for baseline characteristics. Multivariate Cox regression to assess the risk of 30-day readmission was not statistically significant. Predictors of 30-day all-cause readmission among baseline characteristics and subgroups of embolic complications are shown in table 4 and table 5, respectively. Conclusion The prevalence of septic emboli-related complications was up to 42.6% of patients admitted with the primary diagnosis of IE. These complications significantly impact hospital outcomes; including mortality, length of stay and total cost. Further studies are required to clarify the relationship between 30-day all-cause readmissions and embolic complications. Disclosures All Authors: No reported disclosures